Sole on Fire?
By Jessica Poole, Certified Athletic Trainer
*Full disclaimer: These are techniques I have used to treat my patients over the past 15 years. Research, personal experience and patient response have created this body of knowledge. If you have limiting pain, schedule a visit with your orthopedist. If you are currently under the care of a physician and/or physical therapist or athletic trainer, please faithfully follow their course of treatment. There is a method to their prescription, do not mess with it! They know what will work best for you. This is meant to be general information and some tricks to try at home once you are no longer under the care of a physician. This does not replace a doctor’s visit if you are in pain! Thank you. *
What is the plantar fascia?
The plantar fascia is a band of tissue that runs from the bottom of the heel (calcaneus) and fans out across the ball of your foot (metatarsal heads). Its purpose is to support the small muscles on the sole of the foot, maintain the arch and act as a rigid lever, along with musculature, for propulsion. When our foot strikes the ground, the muscles contract and the plantar fascia becomes rigid, creating a windlass to offer a rigid lever for us to push forward in our gait.1
So what is plantar fasciitis?
Inflammation of the plantar fascia. Due to some biomechanical or traumatic force, the fascia becomes inflamed, therefore causing pain and immobility.
How does plantar fasciitis occur?
There are several reasons one may suffer from plantar fasciitis. Most commonly overuse and poor biomechanics are to blame. Acute trauma, nerve entrapment, heel spurs, tight Achilles tendon, inappropriate shoes, age and arch collapse, and high or absent arches can cause inflammation. In my experience, most often, problematic foot mechanics (over pronation, fallen arches, high arches, flat feet) coupled with overuse leads to tight calf muscles and plantar fascia pain. The tight calf muscles cause a tight Achilles tendon which causes a lack of foot flexion (dorsiflesion) which then leads to inflammation. It’s a vicious cycle and unless the root cause is corrected, we can treat symptoms, but it never goes away.4,5
- So what are the common signs and symptoms of plantar fasciitis?
- Pain in the arch and sole of the foot, especially when touched
- Pain with weight bearing after sitting or sleeping for lengths of time
- Pain may decrease as you move about, but will return after a sedentary moment and increase in the evening
- Decreased range of motion, especially dorsiflexion, in the foot
- Tight calf muscles and Achilles tendon
- May have swelling in the arch.4
What can be done about plantar fasciitis?
Start with isolating the cause of the foot pain. I begin with lots of questions related to overuse. Have you changed shoes? Have you increased mileage or activity rapidly? Have you drastically changed running, exercise surfaces? How old are your training shoes? What type of arch support is in your training shoes (cleats and turf shoes have terrible arch support) Are you resting or cross training? Are you running on canted surfaces? Do you stretch your calves regularly? Drastic changes in training, weight gain/loss or shoe design can spur inflammation.
Once info is gathered there, I assess how the patient’s foot moves and reacts to weight bearing. This will provide clues to the correct type of shoe and whether orthotics may be beneficial. You can seek out a good Athletic Trainer, PT or shoe store for a gait assessment. Shoe stores that cater to runners are the places to go to buy shoes and have foot assessments.
Once the cause of the inflammation is discovered, we can begin to correct the problem and treat the inflammation. Research shows the best way to reduce pain and prevent plantar fasciitis is by stretching the gastroc soleus complex (calf muscle) therefore stretching the Achilles tendon and increasing motion of the ankle. Prolonged calf stretching as well as high load strengthening of the gastrocnemius muscles has shown improvement in pain. High load strengthening is simple, place your toes on a step and sink down into a calf stretch. Once you are stretching the calf, raise up onto your toes. Moving from a state of stretch into an explosive contraction followed by returning to a deep stretch will improve your strength and flexibility quickly and decrease pain. This technique has worked on several of my patients, it’s my favorite trick. Finally, rolling your arch over a can of beans or a tennis ball first thing before weight bearing makes walking more bearable. Rolling your arch over a frozen bottle of water after exercise, at the end of the day or as often as necessary will deliver the benefits of cold therapy.2,3
Remember to see a doctor should your pain start to cause you to limp. My advice is that, advice, and the direction of a doctor, PT or ATC is your best weapon to this pest… With that explained, cool off your soles and stay healthy my friends.
My brain received some help from the following sources. Great reads, all of them…
1. Bolgla, L. A., & Malone, T. R. (2004). Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. Journal of athletic training, 39(1), 77.
2. Kumar, S., & Motimath, B. (2015). Effect of Short duration Targeted Manual Therapy Approach in Plantar Fascitis–a Randomized Control Trial. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal,9(1), 193-197.
3. Rathleff, M. S., Mølgaard, C. M., Fredberg, U., Kaalund, S., Andersen, K. B., Jensen, T. T., ... & Olesen, J. L. (2015). High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine & science in sports,25(3), e292-e300..
4. Starkey, C., & Brown, S. D. (2015). Examination of Orthopedic & Athletic Injuries. FA Davis
5. van Leeuwen, K. D. B., Rogers, J., Winzenberg, T., & van Middelkoop, M. (2015). Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. British journal of sports medicine, bjsports-2015.